Abby Parks had never heard of parvovirus when she began experiencing flu-like symptoms in late April, followed by joint pain and a rash.
Parks, 27, a special education teacher in Springfield, Illinois, was about 18 weeks pregnant and had been feeling very sick with a fever for days, but tests for Covid and strep came back negative.
The school nurse, who had been treating students with “very pink and red cheeks,” suggested that Parks might have the same infection.
“I got progressively sicker,” he said. “I was in bed with a fever for four or five full days.”
When blood tests performed by her obstetrician-gynecologist came back positive for parvovirus B19 in early May, she was referred to a maternal-fetal medicine specialist. The doctor discovered that the virus had passed to the fetus in utero.
The fetus had developed anemia, a very dangerous condition. Doctors gave the fetus a blood transfusion in utero.
Cases of parvovirus B19, more commonly known as fifth disease or “slapped cheek syndrome” because of the red rash that covers an infected patient’s face, are on the rise in the U.S. On Tuesday, the Centers for Disease Control and Prevention issued an alert to doctors to be on the lookout for signs of the highly contagious seasonal virus.
Most infections occur among children ages 5 to 9, the CDC said. Since March, parvovirus has been circulating in Europe at unusually high rates, according to the European Center for Disease Prevention and Control.
Most adults were infected as children and are still protected. However, the CDC warned that pregnant people and people with sickle cell disease who have never been exposed are at risk for serious illness.
Parks’s doctor, Kathy Bligard, an obstetrician-gynecologist at Washington University Hospital in St. Louis, said: “Abby is not the only patient whose fetus has needed a blood transfusion in the last few months because of parvovirus. It’s certainly something I used to see maybe once every two years and I’ve seen it several times in the last few months.”
Bligard said parvovirus is dangerous for pregnant women because it can cross the placenta and infect the fetus, causing anemia, which could lead to stillbirth.
Parks has recovered from the virus, but her pregnancy is still at risk.
On Wednesday morning, after an ultrasound showed the fetus was not getting enough blood from the placenta, Parks checked into a Springfield hospital to care for the baby.
“I think it saved the fetus’s life,” Parks said of the earlier transfusion. “Because if that anemia had persisted, with that low blood count, the baby could have died,” Parks said in an interview Wednesday from her hospital bed.
Bligard said the virus makes it difficult for the fetus to produce new red blood cells. “To get oxygen to all the important organs in our body, our body relies on those red blood cells. So it can cause heart failure or even progress to death if you have low blood counts.”
Although the disease primarily affects children, when adults get it, it can cause more severe symptoms, such as joint pain and anemia, which result from problems creating red blood cells, said Dr. Vincent Iannelli, a Dallas-area pediatrician. Low red blood cell counts can lead to pregnancy complications.
Patients with sickle cell anemia are also at high risk.
“Over the last two months, I think we’ve seen more cases,” Iannelli said. Normally, Iannelli would see one case of fifth disease per month; he said he now sees one or two cases per week, noting that the virus is most common in the spring and summer.
What are the symptoms of fifth disease?
In children, fifth disease is usually mild: Its most distinctive symptoms include fever and respiratory symptoms, followed by a red rash on the cheeks and then a lace-like rash on the rest of the body, which may be itchy.
The rash appears toward the end of the infection and typically goes away in seven to 10 days, but can last for several weeks. Importantly, a person with fifth disease is no longer contagious once the rash appears. “Unfortunately, by the time you know your child has it, they’re no longer contagious,” Iannelli said.
The rash may become more pronounced with heat and sunlight, but it doesn’t make the infection worse, Iannelli said.
Pregnant women who experience symptoms such as joint pain and problems with red blood cell production should tell their doctors immediately, especially if they know they have been in contact with patients infected with Fifth disease, doctors say.
Iannelli does not believe that the increase in cases is cause for alarm.
“Fortunately, most pregnant women had it as children, so they are immune, but we do occasionally see adults,” she said.
Ultimately, “if you’re healthy, it’s a mild illness,” Iannelli said. “If you have immune system issues or if you’re pregnant, you should tell your doctor early in your pregnancy. But for everyone else, it’s basically a rash.”
He noted that the CDC alert was intended to raise awareness among physicians, not to worry the public.
Why is it called fifth disease?
In the early 20th century, doctors developed a list of common childhood rashes to help them be more precise in their diagnoses. They identified six main rashes:
There are now more recognized childhood rashes, such as chickenpox, so the numbering system is no longer used except for Fifth disease.
At the hospital, Parks, now 30 weeks along, is being closely monitored. She wants other pregnant women to be aware of the virus and get tested if they have been exposed.
“It was really the most difficult experience we’ve ever been through,” Parks said. “It wasn’t guaranteed that I would outgrow fetal anemia.”
